AS I SEE IT
Prepare Now for the New ICD-10 Deadline Insider tips for addressing physician needs, preparing for cash-flow problems and creating a comprehensive fall-back plan BY CRISTINA BENTIN
During April, President Barack Obama signed legislation delaying the compliance deadline for ICD-10 (10th revision of
the International Statistical Classifi- cation of Diseases and Related Health Problems) for at least another year. Despite the delay, now is the time for ASCs to move beyond assessment and planning and begin to prepare to implement the new system.
Recent ICD-10 education conferences
have been eye-opening events that have driven home the need for ASCs that are preparing for the new deadline to address at least three top concerns: physician readiness, budgets and con- tingency plans.
I. Physician Documentation Understandably, stomachs are churning when considering the overall educa- tion process involved in implementing ICD-10—a process that needs to include business office staff, clinical/nursing staff and physicians. While most ASCs are educating their staff, the discon- nect often lies with disseminating spe- cific documentation deficiencies to all physicians actively performing cases. For years, ASC staff have been
advised to trend physician documenta- tion deficiencies to include implement- ing inquiry protocols when applicable and according to both individual orga- nization and state policies. Current documentation deficiencies won’t go away with the implementation of ICD- 10 and will assuredly be compounded due to the higher specificity require- ments. Unspecified or ambiguous cod- ing will no longer fly through the radar
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due to the increased specificity needed for diagnosis assignment. Let’s look at a few documentation changes for three top ASC specialties:
Orthopedics
Left, right, bilateral determination is mandatory when applicable. “Closed” versus “open” fractures as
well as “displaced” versus “nondisplaced” fracture clarification is required. Ironi- cally, ICD-10 defaults to “displaced” when physician documentation does not specify “displaced” versus “non-dis- placed.” The physician knows whether the fracture is displaced and will need to be queried if the documentation is not provided. Acute versus chronic conditions are required for correct diagnosis code assignment. ICD-10 chapter guidelines direct the user to clarify with the phy- sician when documentation is not spe- cific to determine an assignment of an “acute” versus a “chronic” condition.
The coder should not be placed in the position of practicing medicine. It is the surgeon’s responsibility to determine a “chronic” versus an “acute” condition. Gustilo, Neer, Salter-Harris report- ing is required for ICD-10 diagnosis assignment. Specificity in the type/ degree of open fractures, the num- ber of parts/displacement of proximal humeral fractures, and the Type I, II, III, IV, etc., classification of physeal fractures must be indicated within the operative report. The surgeon should provide the specific type and/or num- ber of fracture parts pending the classification applicable and utilized for diagnosis code assignment. Initial and subsequent 7th charac- ters for diagnoses should not be mis- interpreted by physician office staff to mean the same as a physicians’ “new” versus “established” office visits. Chapters 13 and 19 utilize these more common 7th characters and other more defined 7th characters when applica- ble. An established patient visit from the physician office standpoint may be reported from a diagnosis aspect with a 7th character A when a patient is receiving active treatment for a con- dition (e.g., a surgical procedure). Applicable 7th character assignment to a diagnosis will change pending the circumstance. From the facility per- spective, facilities should understand the 7th character A is used while the patient is receiving active treatment for the condition. The 7th Charac- ter D is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the heal- ing or recovery phase. All 7th charac-
The advice and opinions expressed in this article are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. ASC FOCUS JUNE/JULY 2014
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